Bay Area health officials are on alert as record-shattering coronavirus numbers raise concerns once more about the lack of personal protective equipment available to keep frontline workers safe.
After the initial scramble to find enough equipment in the pandemic’s early days, some hospitals and public health officials across the Bay Area say they now have enough protective gear in place, or plans in place to get it. But replenishing stockpiled supplies could become harder as the outbreak worsens nationally.
“We are experiencing some issues in terms of obtaining (protective equipment), likely due to the increased national demand for (protective equipment) supplies,” Dr. Grant Colfax, director of the San Francisco Public Health Department, said in a press briefing Wednesday.
It doesn’t help that coronavirus hospitalizations in the Bay Area are also surging, with a record high of 665 patients Thursday. While some officials said they feel better about supplies now compared to months ago, management and health care workers often differ on how much equipment is “enough.” Some facilities are reusing N95 masks, following loosened federal guidelines that some workers fear won’t adequately protect them.
Bay Area public health departments track whether medical facilities have stockpiled protective equipment. As of this week, San Mateo County facilities said they had a two-week supply. Contra Costa and Marin counties had enough for a month. Facilities in Alameda, Santa Clara, and San Francisco counties did not have a 30-day supply.
Jim Morrissey, medical health operational area coordinator with Alameda County emergency medical services, said the county has ample supplies to distribute to facilities within a day. The county has stockpiled enough protective equipment to last up to six months, he said. Since March, the county distributed 4.6 million items, ranging from a gallon of hand sanitizer to a box of gloves. Morrissey said supply pipelines are now opening up, so he encourages facilities to go back to their vendors or search on Amazon to find items.
“Get what you can, when you can, if you can, and as much as you can,” said Morrissey. “You continue to think ahead to say this is going to get worse.”
Other counties struggle more: a Contra Costa public health department spokesman said “supplying requests from facilities is an ongoing challenge” and the state and federal government are the county’s largest suppliers.
Dr. Joshua Adler, chief clinical officer for UCSF Health, said the hospital system received no usable shipments of N95 masks for months and relied on internal supplies and donations. Several weeks ago, deliveries began trickling in.
Adler said he feels better about supplies than he did – but still not great – despite having more coronavirus patients than ever before. But he pointed out that smaller doctor’s offices still feel stressed and struggle to obtain supplies.
At Good Samaritan Hospital in San Jose, chief nursing officer Mark Brown said they have a four- to six-month supply in hand. The hospital still has at least 95,000 N95 masks left over from a county and San Jose police donation months ago and expects another 100,000 from the county next week.
“Even if it gets really bad in Northern California, we feel we have a good process in place with our supplies, … We can manage them properly and protect our staff and physicians,” Brown said.
Hospitals have found ways to stretch supplies, such as switching to washable gowns and asking workers to wear the same N95 mask for a shift. They’re following Centers for Disease Control and Prevention guidelines, which allow for reuse when properly removing and storing masks.
These guidelines changed after the pandemic and were driven by supply shortages, said Dr. David Rempel, an epidemiologist and emeritus professor at UCSF Department of Medicine and UC Berkeley College of Engineering. Past research shows reusing masks increases exposure risks, but it’s not been proven how much, he added.
Across California, 18,857 health care workers have been infected with the virus and 105 have died. Many workers protest reusing masks they were trained to throw away after one use.
“Five months now into this pandemic, we are still rationing our (protective equipment),” John Pasha, an ICU nurse at Good Samaritan, said. “We’re still not at a place where we’re practicing the gold standard of care.”
The California Nurses Association is demanding President Trump enact the Defense Production Act and force factories to make masks.
“The United States is the richest country in the world, and we can’t get the safety equipment we need to adequately protect health care workers,” said Deborah Burger, a nurse at Kaiser Permanente Santa Rosa Medical Center and co-president of the union.
Some hospitals have turned to decontamination instead. National company Battelle, which has a Fremont site, got a contract from the federal government to decontaminate masks at no cost to hospitals. The company acknowledges reuse is not ideal.
“A new mask is best, but if there’s no mask available, this is a solution for that problem,” Brandon Wood, research statistician and Fremont site manager, said.
Battelle’s decontamination process uses hydrogen peroxide vapor, a common method for hospital sterilization. The method, tested in a two-year study conducted before the pandemic, was authorized for emergency use by the Food and Drug Administration earlier this year. Masks can be reprocessed up to 20 times without degrading the filter quality, the study said.
The Fremont site has decontaminated more than 100,000 masks since May 1, Wood said. The site, which usually receives between 20 to 30 boxes a day, saw a spike to 59 on Monday.
Most Bay Area hospitals are not using decontaminated masks yet. Good Samaritan received masks back from Battelle but is storing them; UCSF has boxes ready to send off if the need arises.
Rempel, who has studied decontamination for months with a national research group, said hydrogen peroxide vapor has proved effective in removing the virus, but there are always concerns about making sure the chemical process is done correctly and how many times it’s safe to reuse.
He was shocked mask manufacturing hasn’t met the demand yet: “I think it’s nuts.”
Mallory Moench is a San Francisco Chronicle staff writer. Email: [email protected] Twitter:@mallorymoench
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